Percutaneous Placement of Amplatzer Duct Occluder Device to Seal a Saphenous Vein Graft Pseudoaneurysm

摘要

Aneurysmal dilation of saphenous vein graft is a rare but serious complication of coronary artery bypass grafting with an estimated incidence of less than 1% [1]. Its exact mechanism of formation is not entirely known. However, vascular trauma, imperfect suture placement and atherosclerotic degeneration are amongst the proposed pathophys-iology. Conservative management, percutaneous closure as well as surgical resection have been employed in their management. However the optimal approach is yet to be explored. In the recent years, the applications of Amplatzer devices have been expanded beyond their original indications with a few case reports demonstrating their use in the closure of saphenous vein graft aneurysms and pseudo-aneurysms (SVGAs). We report the case of a 76 year old man who presented with a ruptured saphenous vein graft pseudo-aneurysm that was successfully sealed with an Amplatzer duct occluder II device. To our knowledge, this is the first reported case of aneurysmal dilation of saphenous vein graft managed with Amplatzer duct occluder II. Our case highlights the usage of duct occluder device as an effective strategy to close SVGAs. We also review the literature pertaining to SVGAs managed with Amplatzer devices.